SCTG Webinar: Integrating Trauma-Informed Approaches within MTSS

1. SCTG Webinar:Integrating Trauma-Informed Approaches within MTSS Lucille Eber and Susan Barrett National PBIS TA Center January 26, 2017

2. BIG Ideas • How can trauma-informed interventions enhance the PBIS/behavioral health system in schools? • When should trauma-informed approaches be used and at what tiers? • How can the core features of an Interconnected Systems Framework (ISF) support and guide the implementation of trauma-informed approaches in schools?

3. Agenda • Using an Interconnected Systems Framework • What is trauma? • Prevalence? • Impact on Schools? • Trauma-informed Across Tiers • Tier 1 Curriculum Examples • Tier 2 Implementation Example • Summarizing

4. ISF National Leadership Team • Susan Barrett, Director, Mid-Atlantic PBISsbarrett@midatlanticpbis.org • Lucille Eber, Director, Midwest PBIS lucille.eber@midwestpbis.org • Bob Putnam, Executive Vice President of PBIS and Consultation, May Institute bputnam@mayinstitute.org • Kelly Perales, Director of Training and Technical Assistance PBIS/MH Integration, Midwest PBIS Network kelly.perales@midwestpbis.org • Mark Weist, Professor, Clinical-Community and School Psychology, U South Carolinaweist@mailbox.sc.edu • Sharon Stephan, Co-Director, CSMHsstephan@psych.umaryland.edu • Nancy Lever, Co-Director, CSMHnlever@psych.umaryland.edu • Elizabeth Connors, Assistant Professor, Director Performance Measurement, CSMH econnors@psych.umaryland.edu • Joni Splett, Assistant Professor, University of Florida splett@coe.ufl.edu • Ashley Quell, University of South Carolina quell@mailbox.sc.edu

5. Special Thanks: • Wisconsin Department of Education: Nic Dibble, JustynPoulos, Kathyrn Bush, Elizabeth Cook (and their colleagues and partners) • WI Department of Public Instruction Trauma-Sensitive Schools Resourceshttp://sspw.dpi.wi.gov/sspw_mhtrauma

6. Wisconsin DPI Why use the PBIS framework for trauma-sensitive schools?The fundamental purpose of PBIS is to make schools more effective & equitable learning environments. Rob Horner, Co-Director of the OSEP Technical Assistance Center for PBIS Predictable Positive Consistent Safe WI Department of Public Instruction Trauma-Sensitive Schools Resourceshttp://sspw.dpi.wi.gov/sspw_mhtrauma

7. Advancing Education Effectiveness: Interconnecting School Mental Health & School-Wide Positive Behavior Support Editors: Susan Barrett, Lucille Eber& Mark Weist National PBIS TA Center Center for School Metal Health IDEA Partnership NASDSE https://www.pbis.org/school/school-mental-health/interconnected-systems

8. Structure and process for education and mental health systems to interact in most effective and efficient way. Guided by key stakeholders in education and mental health/community systems Who have the authority to reallocate resources, change role and function of staff, and change policy. ISF Definedhttps://www.pbis.org/school/school-mental-health/interconnected-systems

9. ISF Core Features • Effective teams that include community mental health providers • Data-based decision making • Formal processes for the selection & implementation of evidence-based practices (EBP) • Early access through use of comprehensive screening • Rigorous progress-monitoring for both fidelity & effectiveness • Ongoing coaching at both the systems & practices level

10. Why use the Interconnected Systems Framework (ISF) for integrating trauma-informed practices in sensitive schools? Beyond Access: Fidelity & Outcomes Single System of Delivery MH is for ALL MTSS: Teams, Data, Screening Continuum of EBPs

11. Poll #1 • Are you familiar with trauma informed care/approaches?

12. Poll #2 Do you have any experience applying trauma informed care/approaches in schools?

13. Poll #3 If “yes” are your experiences at Tier 1? Tier 2? Tier3?

14. Where do specific “MH” Interventions Fit? That depends on the data of the school & community Examples of Expanded View of Data • Child welfare contacts • Violence rates • Incarceration rates • Deployed families • Homeless families • Unemployment spikes

15. Trauma-sensitive schools Trauma-sensitive schools recognize the prevalence & impact of traumatic occurrence in students’ lives & create a flexible framework that provides universal supports, is sensitive to the unique needs of students & is mindful of avoiding re-traumatization. WI Department of Public Instruction Trauma-Sensitive Schools Resourceshttp://sspw.dpi.wi.gov/sspw_mhtraumaAdapted from Helping Traumatized Children Learn

16. WI Department of Public Instruction Trauma-Sensitive Schools Resourceshttp://sspw.dpi.wi.gov/sspw_mhtrauma

17. What is trauma? • Trauma refers to extreme or chronic stress that overwhelms a person’s ability to cope & results in feeling vulnerable, helpless & afraid • Can result from one event or a series of events • Event(s) may be witnessed or experienced directly • Experience is subjective • Often interferes with relationships; self regulation; & fundamental beliefs about oneself, others & one’s place in the world WI Department of Public Instruction Trauma-Sensitive Schools Resourceshttp://sspw.dpi.wi.gov/sspw_mhtrauma

18. Do you have students with these experiences? • Simple trauma • Serious accident (e.g., auto) • Disaster (e.g., tornado, house fire) • Physical or sexual assault • Complex/developmental trauma • Witness to domestic violence • Physical, emotional or sexual abuse • Neglect • Homelessness • Living in homes with family members with untreated mental illness or substance abuse • Having a family member serving overseas in the military • Historical/generational trauma WI Department of Public Instruction Trauma-Sensitive Schools Resourceshttp://sspw.dpi.wi.gov/sspw_mhtrauma

19. Prevalence of Trauma in Students 13 of every 30 students in a classroom experience toxic stress from 3 or more Adverse Childhood Experiences (ACEs) WI Department of Public Instruction Trauma-Sensitive Schools Resourceshttp://sspw.dpi.wi.gov/sspw_mhtraumaSource: Washington State Family Policy Council

20. Trauma & Brain Development Typical Development Developmental Trauma WI Department of Public Instruction Trauma-Sensitive Schools Resourceshttp://sspw.dpi.wi.gov/sspw_mhtrauma Adapted from Holt & Jordan, Ohio Dept. of Education

21. Trauma affects learning • Adversely affects students’ ability to … • Acquire language & communication skills • Understand cause & effect • Take another person’s perspective • Attend to classroom instruction • Regulate emotions • Engage the curriculum • Utilize executive functions • Make plans • Organize work • Follow classroom rules WI Department of Public Instruction Trauma-Sensitive Schools Resourceshttp://sspw.dpi.wi.gov/sspw_mhtrauma The Heart of Learning & Teaching Compassion, Resiliency & Academic Success (Wolpow et al, 2009)

22. Trauma affects school performance • Lower scores on standardized achievement tests (Goodman et al, 2011) • Substantial decrements in IQ, reading achievement & language (Delaney-Black et al, 2002) • 2.5x more likely to be retained (Grevstad, 2007; Sanger et al, 2000; Shonk et al, 2001) • Suspended & expelled more often (Grevstad, 2007; Sanger et al, 2000; Shonk et al, 2001) WI Department of Public Instruction Trauma-Sensitive Schools Resourceshttp://sspw.dpi.wi.gov/sspw_mhtrauma Daniel & Zarling (2012)

23. Trauma changes our physiologyfight, flight or freeze response Noticeable Effects Hidden Effects Brain prepares body for action Adrenaline released Blood pressure rises Liver releases glucose to provide energy for muscles Digestion slows or ceases Cortisol released (depresses immune system) • Pupils dilate • Mouth goes dry • Muscles tense • Heart pumps faster • Breathing rate increases • Chest pains • Palpitations • Perspiration • Hyperventilation WI Department of Public Instruction Trauma-Sensitive Schools Resourceshttp://sspw.dpi.wi.gov/sspw_mhtrauma

24. What if this bear walked into this room right now? • How are you feeling? • What are you going to do? • Flee? • Fight? • Freeze? • Are you listening to the presentation? • Critical learning – to many students impacted by trauma, adults are “bears” that sometimes are very dangerous WI Department of Public Instruction Trauma-Sensitive Schools Resourceshttp://sspw.dpi.wi.gov/sspw_mhtrauma

25. Misreading cues • Young children impacted by trauma spend much time in a low-level state of fear learning to read adults’ non-verbal cues to keep themselves safe • Their safety depends upon knowing when an adult becomes a “dangerous bear” • Student may not interpret innocent or neutral looks, actions, & touches from others at school as benign • Difficult for student to re-learn these cues as meaning different things in different environments WI Department of Public Instruction Trauma-Sensitive Schools Resourceshttp://sspw.dpi.wi.gov/sspw_mhtrauma Adapted from Chris Dunning

26. Impact on student’s view of world Developmental Trauma Typical Development vs. • I live in a predictable & benevolent world • I am worthwhile • I am hopeful & optimistic about my future • I have the ability to impact & change my life • The world is not safe • People want to hurt me • I am afraid • No one will help me • I am not good/smart/ worthy enough for people to care about me • It will never get better • I need to establish personal power & control WI Department of Public Instruction Trauma-Sensitive Schools Resourceshttp://sspw.dpi.wi.gov/sspw_mhtrauma

27. Higher baseline state of arousal • These students may be in a persistent physiological state of alarm • (constant “yellow alert”) • Likely to be more reactive than peers, as external stressors are introduced (e.g., complicated task at school, disagreement with a peer) • Fight, flight, freeze • Over-reading possibility of threat leads to lower brain functioning & impulsive acts • e.g., striking out physically or verbally, leaving the classroom, shutting down • Student views his/her actions as defensive & justified WI Department of Public Instruction Trauma-Sensitive Schools Resourceshttp://sspw.dpi.wi.gov/sspw_mhtraumaAdapted from Chris Dunning

28. Lack of personal power or control • Unexpected change • Feeling threatened or attacked • Feeling vulnerable or frightened • Feeling shame • Positive feelings or intimacy Triggers can be internal and/or external Key Triggers for Students Impacted by Trauma WI Department of Public Instruction Trauma-Sensitive Schools Resourceshttp://sspw.dpi.wi.gov/sspw_mhtrauma

29. Trauma & behavior • Behavior is the language of trauma, especially for children • Most children lack the language skills to describe how they are feeling, so behavior is their expression • Most expressive behaviors used by these children are considered “negative” • Reactive, impulsive, aggressive, withdrawn, defiant • Other behaviors – perfectionistic, lack of trust in adult & peer relationships • Many of the most challenging behaviors are strategies that have helped the child to survive abusive or neglectful situations & have been generalized to other environments (e.g., school) • WI Department of Public Instruction Trauma-Sensitive Schools Resourceshttp://sspw.dpi.wi.gov/sspw_mhtrauma • Adapted from Chris Dunning • The Heart of Learning & Teaching Compassion, Resiliency & Academic Success (Wolpow et al, 2009)

30. How do we see these students? Uninformed view Trauma-informed view Maladaptive responses (in school setting) Seeking to get needs met Difficulty regulating emotions Lacking necessary skills Negative view of world (e.g., adults cannot be trusted) Trauma response was triggered Trauma-informed response Student needs to learn skills to regulate emotions & we need to provide support • Anger management problems • May have ADHD • Choosing to act out & disrupt classroom (e.g., disrespectful or manipulative) • Uncontrollable, destructive • Non-responsive Uninformed response • Student needs consequences to correct behavior or maybe an ADHD evaluation WI Department of Public Instruction Trauma-Sensitive Schools Resourceshttp://sspw.dpi.wi.gov/sspw_mhtrauma Adapted from Daniel & Zarling (2012)

31. The needed perspective shift WI Department of Public Instruction Trauma-Sensitive Schools Resourceshttp://sspw.dpi.wi.gov/sspw_mhtrauma

32. Teacher responses to student outburst “Ashley just transferred into my 5th grade classroom after being placed in foster care. I wanted to make her feel welcome. I moved to put my hand lightly on her shoulder when I was explaining an assignment & she slapped my hand away. Then she stared at me defiantly.” • Teacher response #1 – teacher-centered • Teacher response #2 – student-centered WI Department of Public Instruction Trauma-Sensitive Schools Resourceshttp://sspw.dpi.wi.gov/sspw_mhtrauma

33. Uninformed teacher response “Why she just decided to slap me is beyond me. I was trying to be helpful & welcoming. Her reaction was totally out of proportion to the situation. Physical aggression simply cannot be tolerated or excused. She needed to learn that right away. There had to be immediate & significant consequences if I’m to maintain order in my classroom. When I tried to remove Ashley to the office, she just lost it. Instead of complying, she chose to struggle & started kicking me. I don’t like to see students suspended from school, but Ashley needs to learn that she cannot behave that way in school.” WI Department of Public Instruction Trauma-Sensitive Schools Resourceshttp://sspw.dpi.wi.gov/sspw_mhtrauma

34. Trauma-informed teacher response “I must have frightened Ashley without meaning to. It’s clear she does not want to be touched. She may have other triggers, as well. Right now she is hyper-aroused & feels cornered. If I put any extra demands or expectations on her right now, she could escalate & that will just make the situation worse. I told Ashley we would talk about what just happened when she calms down. I need to help her feel safe or she won’t be able to learn in my classroom. I know it’s common for kids in foster care to have trauma. I need to find out more about what her needs are, maybe from her school records or from her foster parents & the caseworker. If I need to, I’ll contact our Building Consultation Team for support.” WI Department of Public Instruction Trauma-Sensitive Schools Resourceshttp://sspw.dpi.wi.gov/sspw_mhtrauma

35. Cues to Use “Alternative Behavior Lens” • Known history of potentially traumatizing events or traumatic stress • Behavioral responses are rapid &/or disproportionately intense given the stimulus • Traditional approaches & responses not successful • Efforts to teach alternative behaviors not working • Rewards/consequences are activating • Traditional FBA approach not successful • Antecedent behaviors & patterns hard to identify (i.e., no pattern to where & when behavior occurs & who is present) • Function of behavior may be neurological & not observable (i.e., not outcome driven) WI Department of Public Instruction Trauma-Sensitive Schools Resourceshttp://sspw.dpi.wi.gov/sspw_mhtraumaAdapted from Zivsak, Vidimos, & Mack

36. Trauma-informed Interventions Across the Tiers

37. Poll #4 Are your systems using data to identify students who may need Trauma informed interventions? Yes No If yes, please share what data and how used in chat box.

38. 2 – 4 Years The Need to Be Plan-ful Implementation occurs in stages • Exploration-Adoption • Installation • Initial Implementation • Full Implementation • Innovation • Sustainability Fixsen, Naoom, Blase, Friedman, & Wallace, 2005

39. Which Tier? Depends on your Data Tier 3 – Intensivemental health supports designed to meet the unique needs of students who already display a concern or problem. Tier 2 – Targetedmental health supports provided for groups of students identified as at risk for a concern or problem. Tier 1 – Universalsupports that all students receive. Promoting wellness & positive life skills can prevent or reduce mental health concerns or problems from developing.

40. School-wide Base Rate

41. Tier 1: Classroom System # of Schools First things first! Core Team Trained in Best Practices

42. 1. Expectations 2. NATURAL CONTEXT (Locations) Invite those sitting alone to join in • Have a lunch plan and choose quiet or social lunch area • Invite friends to join me Expectations 3. Rules or Specific Behaviors • Use my breathing technique • Listen to my signals

43. Installing a Trauma Approach within the Framework of PBIS Step 1: What does the data say? (community demographic, screening info. Attendance patterns, discipline patterns, climate surveys, fidelity checks) Where and what time are vulnerable decision points most like to occur? The most significant concern is defined as that is taking place most often in _____________ location). This behavior occurs (frequency/quantify behavior), and is most likely to happen (time of day) . Students from (group of students/grade level) are most frequently engaging in ________. This may be due to ___________. Step 4: Trauma informed Lens How do we teach staff the knowledge necessary skills? How do we support staff to implement with fidelity? Professional Learning Communities used to support one another in development of practices. How do we use data to monitor progress toward our goal and inform each other? How do we improve ? DATA – Supports Decision Making SYSTEMS – Support Staff Behavior Step 2: What is the SMART (specific, measureable, attainable, realistic, time-bound) goal? Step 3: What will we do to support student behavior and provide necessary skills to regulate emotion and skills to manage stress and anxiety ? Promote predictable, positive, safe, and consistent environments by: -Develop caring connections (e.g. morning meetings) -Teach expectations, replacement skills -Develop acknowledgement system Layered Daily Progress Report with additional time for acquiring coping skills PRACTICES – Support Student Behavior

44. Review Students’ Mental Health Needs: Local Data Sources • Data from your school or district • disciplinary data • truancy data • dropout rates • school counselors’ data on number of students served in a school year • Data from the community mental health partners • number of students served by zip code/catchment area • number of students with different diagnoses • number of students who received different services

45. Daily Progress Report (DPR) Sample NAME:______________________ DATE:__________________ Teachers please indicate YES (2), SO-SO (1), or NO (0) regarding the student’s achievement in relation to the following sets of expectations/behaviors. Adapted from Grant Middle School STAR CLUB Adapted from Responding to Problem Behavior in Schools: The Behavior Education Program by Crone, Horner, and Hawken

46. Daily Progress Report (DPR) Sample NAME:______________________ DATE:__________________ Teachers please indicate YES (2), SO-SO (1), or NO (0) regarding the student’s achievement in relation to the following sets of expectations/behaviors. Example of skills taught in Tier 2 Groups” Walk to classKeep hands to self Use appropriate languageRaise hand to speak Bring materials Fill out assignment notebook Adapted from Grant Middle School STAR CLUB Adapted from Responding to Problem Behavior in Schools: The Behavior Education Program by Crone, Horner, and Hawken

47. “Individualized Student Card linked to Tier 3 FBA/BIP" Daily Progress Report (DPR) Sample NAME:______________________ DATE:__________________ Teachers please indicate YES (2), SO-SO (1), or NO (0) regarding the student’s achievement in relation to the following sets of expectations/behaviors. Use your words Use deep breathing Keep arm’s distance Use #2 voice level when upset Ask for breaks Self-monitor with DPR Adapted from Grant Middle School STAR CLUB Adapted from Responding to Problem Behavior in Schools: The Behavior Education Program by Crone, Horner, and Hawken

48. Daily Progress Report (DPR) Sample NAME:______________________ DATE:__________________ Teachers please indicate YES (2), SO-SO (1), or NO (0) regarding the student’s achievement in relation to the following sets of expectations/behaviors. Trauma-Informed Tier 2 Group Self-Check Use calming strategy Use your words Use safe hands Ask for help Connect with safe person Adapted from Grant Middle School STAR CLUB Adapted from Responding to Problem Behavior in Schools: The Behavior Education Program by Crone, Horner, and Hawken

49. Daily Progress Report (DPR) Sample NAME:______________________ DATE:__________________ Teachers please indicate YES (2), SO-SO (1), or NO (0) regarding the student’s achievement in relation to the following sets of expectations/behaviors. “Tier 2 Trauma-Informed Group DPR” SOS (slow down, orient, self-check) Use mindfulness Distract & Self-Soothe Let ‘M Go Make A Link Make Meaning Adapted from Grant Middle School STAR CLUB Adapted from Responding to Problem Behavior in Schools: The Behavior Education Program by Crone, Horner, and Hawken

50. Poll #5 Has your system explored/adopted specific evidence-based interventions for students who have experienced trauma? Yes No If yes, please share in chat box.